Healthcare Provider Details

I. General information

NPI: 1326270679
Provider Name (Legal Business Name): MICHELLE ANN CAWLEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 MENTOR AVENUE SUITE 210B
MENTOR OH
44060
US

IV. Provider business mailing address

9485 MENTOR AVENUE SUITE 210B
MENTOR OH
44060
US

V. Phone/Fax

Practice location:
  • Phone: 440-205-5734
  • Fax: 440-205-5735
Mailing address:
  • Phone: 440-205-5734
  • Fax: 440-205-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.10883-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: